Third in a series looking at serious issues with emergency health services in British Columbia.

If you have a story to share with us about your experiences, send an email to newsroom@castlegarnews.com.

Health Minister Adrian Dix has acknowledged that ambulance services in British Columbia need to improve 乌鸦传媒� but it is something that he has been saying for quite a while.

乌鸦传媒淎s opposition MLAs 乌鸦传媒� back to when I was the health critic for the NDP before 2011 乌鸦传媒� we made the case that the relationship both between ambulance paramedics and BCEHS [British Columbia Emergency Health Services] 乌鸦传媒� and between communities and BCEHS had to improve,乌鸦传媒� said Dix.

乌鸦传媒淎s a government, Premier Horgan is committed to improving the ambulance service.乌鸦传媒�

Dix said that some improvements are already taking place, 乌鸦传媒淲e are in the midst of organizing and making improvements to the ambulance service.乌鸦传媒�

乌鸦传媒淚 think you will see a response, for example, soon in the West Kootenays reflecting that 乌鸦传媒� reflecting the fact that we think we can do better.乌鸦传媒�

Dix defends the province乌鸦传媒檚 model of ambulance service, preferring B.C.乌鸦传媒檚 system of everything being under one umbrella, over Alberta乌鸦传媒檚 system that is an amalgamation of over 30 contracts.

When asked about comparisons that show that Alberta has more emergency health services per capita and per kilometre, Dix suggested that more doesn乌鸦传媒檛 always mean better.

乌鸦传媒淥ur goal is to have better service, we think the way that EHS [Emergency Health Services] is integrated into the health care system is the way to go 乌鸦传媒� sometimes that means more and sometimes that means better.乌鸦传媒�

B.C. Forest Safety Ombudsman Roger Harris issued a last fall calling out what he sees as a rural/urban divide in the level of ambulance services provided across the province.

Dix said, 乌鸦传媒淭here are issues with the ambulance services in both urban and rural 乌鸦传媒� some of those issues are different. If an ambulance is off on a call in a given community, the rest of that community in that period can feel quite vulnerable 乌鸦传媒� those are significant issues.乌鸦传媒�

乌鸦传媒淚 think the forest ombudsperson has done a thoughtful report and we need to respond to it 乌鸦传媒� and we will,乌鸦传媒� stated Dix, who says to expect improvements in the coming months.

乌鸦传媒淲e have an obligation to respond in those circumstances with the best possible service,乌鸦传媒� said Dix. He explained, however, that services traditionally supplied by search and rescue organizations will continue on in the same manner.

乌鸦传媒淚t has never been the case that BCEHS paramedics and air ambulances go into areas where it is not safe or practical. But that has always been dealt with in some remote logging operations by the employers. In fact, they are required by the law to provide those services.乌鸦传媒�

As far as how Dix responds to critics that say that if you live beyond Hope or outside of the lower mainland it feels like you don乌鸦传媒檛 deserve or receive the same level of care: 乌鸦传媒淚t乌鸦传媒檚 a point to remember 乌鸦传媒� not so long ago I was one of those critics,乌鸦传媒� he said.

Dix looks to changes coming in BCEHS to make a difference in rural communities.

乌鸦传媒淲hat we are responding to in communities 乌鸦传媒� is a higher level of paramedic training. The whole advent of community paramedicine 乌鸦传媒� which I was an early advocate for 乌鸦传媒� is going to be improving care in communities.乌鸦传媒�

Castlegar News will be looking further at the idea of community paramedicine later in the Critical Condition series.

He also thinks that the staffing model of BCEHS is one of the things that has to change.

乌鸦传媒淚t used to be that the on-call paramedic was a job that people had in addition to a job, say, in the forest industry. The current model that we have been operating on in recent decades 乌鸦传媒� is a model that is out of step with the times in rural BC.乌鸦传媒�

乌鸦传媒淲hen people say that the service has been inadequate in rural B.C. 乌鸦传媒� I agree with that,乌鸦传媒� stated Dix.

乌鸦传媒淭hat乌鸦传媒檚 why we have to respond with better service than we have had. We have to respond with changing times.乌鸦传媒�

乌鸦传媒淗aving just arrived here, and having been the critic,乌鸦传媒� added Dix. 乌鸦传媒淚 don乌鸦传媒檛 say that everything is perfect 乌鸦传媒� I think things have to be improved. We are going to start to do that. Your readers are going to see that over the coming months and years.乌鸦传媒�

Grassroots cries for help

Castlegar city councillor Sue Heaton-Sherstibitoff has been lobbying for better ambulance services for years.

She recently presented a motion to Castlegar乌鸦传媒檚 city council that they join many other communities in endorsing the online being put forward by the BC HEROS organization calling on the government to improve the ambulance service.

The petition has been endorsed by about 20 B.C. communities.

乌鸦传媒淚 keep telling people the system is broken 乌鸦传媒� we have a system from the 1970s where every community had a working hospital,乌鸦传媒� said Heaton-Sherstibitoff.

乌鸦传媒淔or BCEHS to say it is going to take years before the system changes 乌鸦传媒� how many people are going to die in that time?乌鸦传媒�

She would like to see better air ambulance services for her region as well, noting that a minimum four-hour ambulance trip when you are suffering just adds to the trauma of an already difficult situation.

乌鸦传媒淭he system just isn乌鸦传媒檛 working 乌鸦传媒� there is no golden hour for people anymore,乌鸦传媒� said Heaton-Sherstibitoff about that first hour after an injury or health crisis that help can make the most difference.

Another concern she has is that ambulances are being tied up transporting non-urgent patients between facilities, she would love to see some dedicated inter-facility transfer ambulances for the area.

乌鸦传媒淚 wonder how many people have actually died in transport?乌鸦传媒� asked Heaton Sherstibitoff.

乌鸦传媒淓ither open our hospital up 24/7, give us what we need to save the lives of our residents 乌鸦传媒� or put more ambulances here that are fully staffed,乌鸦传媒� she said.

BCEHS responds

BCEHS and Provincial Health Services Authority executive vice president Linda Lupini is the person who is tasked with steering the organization through any changes that will take place. She has been with the organization for about four years.

Comparisons with Alberta show that B.C. has a lot fewer Advanced Life Support (ALS) ambulances 乌鸦传媒� 28 in this province compared to about 250 in Alberta.

When asked if BCEHS plans to drastically increase the number of ALS ambulances and the Advanced Care Paramedics (ACP) required to staff them, Lupini said that is not in the organization乌鸦传媒檚 plans.

乌鸦传媒淲e look at our call volume and the types of calls we get and the number and frequency across the province and then we staff accordingly,乌鸦传媒� she explained. 乌鸦传媒淎 primary care paramedic (PCP) 乌鸦传媒� and primary care paramedics make up most of our workforce 乌鸦传媒� can respond adequately and competently and so can the emergency medical responders that are one level below PCP to most of our calls.乌鸦传媒�

She said that calls that you would send an ACP to would include about two per cent of calls designated as highest acuity such as drowning, trauma and breathing problems and in addition there would be less than 20 per cent of other calls that you would want and ALS car at to support the PCPs.

乌鸦传媒淲e are not really concerned about the number of advanced care paramedics with regard to our high acuity calls. In almost all cases when we need an advanced care paramedic or we think it would enhance our response, we can send an advance care paramedic,乌鸦传媒� said Lupini.

In areas outside of urban centres, however, that would likely require flying them into the site as most ACPs are located in larger cities such as Vancouver.

乌鸦传媒淲e don乌鸦传媒檛 really look at our workforce and say we need more ACPs,乌鸦传媒� said Lupini. 乌鸦传媒淲e look at it and say what are all of the different types of calls we go to, how many are there and how quickly can we get the right care to the patient?乌鸦传媒�

乌鸦传媒淵ou have to look at why you would send an ACP 乌鸦传媒� under what circumstances 乌鸦传媒� and you have to figure out whether you are dealing with the very small percentage of calls which are true trauma calls.乌鸦传媒�

That model is a difficult one for people like Coun. Heaton-Sherstibitoff to accept.

乌鸦传媒淭hey have marginalized us,乌鸦传媒� she said.

乌鸦传媒淚 would think that rural areas would need a higher level of a paramedic as we have major industry where a lot of serious accidents happen and we live in vast areas where we have to travel to get health care. So to say that they乌鸦传媒檙e going to keep those positions in the bigger centres where they already have more hospitals which are closer 乌鸦传媒� doesn乌鸦传媒檛 make sense for rural B.C.乌鸦传媒�

乌鸦传媒淎re rural citizens less important than those in Vancouver? I just feel like if you don乌鸦传媒檛 live in the Lower Mainland, you are treated like second-class citizens. We deserve what they have in Vancouver 乌鸦传媒� we pay our taxes. To say that we don乌鸦传媒檛 need it because the local volume is less is absurd.乌鸦传媒�

Lupini pointed out that there are ACP paramedic specialists that rotate in and out of the dispatch centre where they can talk to crews on the ground and upgrade and downgrade calls.

乌鸦传媒淪o you are getting an ACP乌鸦传媒檚 eyes on a situation,乌鸦传媒� she said.

Lupini also said that the need for an ACP to practice their skill set to maintain it is complicated in situations with low call volumes.

乌鸦传媒淲e do not have frequent situations where a patient has had a bad outcome or died because we did not have an Advanced Care Paramedic,乌鸦传媒� said Lupini.

She emphasized the importance of getting a patient to a trauma centre.

乌鸦传媒淎ll the paramedics at a scene can only do what they can do,乌鸦传媒� she said. 乌鸦传媒淲e need the infrastructure, the equipment, the health-care team, surgery and other interventions. The idea that you can do a lot at the scene is not necessarily the case.乌鸦传媒�

乌鸦传媒淭he best thing you can do as a provincial response is to coordinate your ground crew to get a patient either by helicopter to a fixed wing [airplane] and a fixed wing to Vancouver or a helicopter to a community hospital to stabilize the patient and then decide where is the best trauma centre given the diagnosis,乌鸦传媒� explained Lupini.

She did agree that the closer you are to a trauma centre, the better off you are.

乌鸦传媒淚t乌鸦传媒檚 fair to say that if you live close to a trauma centre you are probably going to be in a better situation if you are suffering trauma than someone who lives very far away. There乌鸦传媒檚 no doubt about that.乌鸦传媒�

乌鸦传媒淚f you ask me whether it would be a huge improvement or enhancement to our response to British Columbians to have everybody at an ACP level 乌鸦传媒� I would have to tell you honestly I乌鸦传媒檓 not sure that is true,乌鸦传媒� she said.

Lupini listed a number of things she thinks are the best way to improve service to rural and remote B.C. They include getting Advanced Care Paramedics in the community paramedicine program, adding more community paramedicine programs, adding permanent part-time positions instead of on-call positions and utilizing technology-enabled health platforms.

Lupini also explained that utilizing more helicopters may not be the best answer for better transportation as in most cases it is necessary to transport a patient farther than a helicopter can fly to get to a trauma centre so more fixed-wing aircraft may offer a better solution.

乌鸦传媒淚f the trauma centres stay the way they are and where they are located in B.C. having more fixed-wing would be a better way to enhance service,乌鸦传媒� she said.

乌鸦传媒淭he Kootenays are always so difficult because the weather changes so quickly there. That is one of the reasons that when we really looked at it we said we definitely need a fixed-wing because we can do more with a fixed-wing in that area.乌鸦传媒�

乌鸦传媒淏CEHS has been looking at rural and remote in a very broad way,乌鸦传媒� added Lupini. 乌鸦传媒淲e want to be creative and innovative in how we respond to some of the health needs in those communities.乌鸦传媒�